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Introduction: Rectus abdominis muscle strains are common and can be debilitating in both professional and amateur athletes who engage in strenuous activity.Case Report: We report a rare case of rectus abdominis muscle tear in an amateur bodybuilder diagnosed by point-of-care ultrasound (POCUS) in the emergency department (ED). The patient had presented to the ED three separate times after strenuous exercise, received costly diagnostic workups, and ultimately was diagnosed on the third visit with grade 2 bilateral rectus abdominis tear. The patient was given appropriate education and sports medicine follow-up. He underwent rehabilitation focused on trunk and core stability. At eight-week follow-up, the patient had made a full recovery.Conclusion: To our knowledge, a case of bilateral rectus abdominis tear diagnosed by ultrasound in the emergency setting has not been previously published. Our case report highlights the utility of POCUS in diagnosing musculoskeletal pathology and preventing costly bounce-back visits.

The purpose of this study was to compare maximal adduction (ADD) and abduction (ABD) force, ADD to ABD ratio (ADD:ABD), inter-limb asymmetries and muscle activity between five isometric hip strength assessment positions. Twenty male athletes performed the following positions: seated (SE), supine at knees with 0° hip flexion (SK0°) and 45° hip flexion (SK45°), and supine at ankles bilaterally (SABI) and unilaterally (SAUNI). Normalised muscle activity (%EMGmax) of adductor longus (ADDLONG), gracilis (GRAC), gluteus medius (GMED), sartorius (SAR), and lower rectus abdominis (RECABD) were also assessed. Significant main effects of assessment position were identified for relative peak force (rPF) and torque (rT), ADD:ABD, ADD asymmetry, and %EMGmax. Significantly greater ADD and ABD rPF and rT were observed in SE and SK45° compared to SABI and SAUNI. SK45° elicited the highest ADDLONG and GRAC %EMGmax during ADD, with SE and SK45° evoking the highest GMED %EMGmax during ABD. SK0° exhibited significantly higher ADD:ABD compared to all positions except SAUNI. ADD asymmetry was significantly largest in SAUNI, and RECABD %EMGmax was highest in SABI during ADD. This data can inform selection of assessment positions based on whether the primary measures of interest are maximal force and muscle activity, or identifying asymmetries. [ABSTRACT FROM AUTHOR]

Desmoid tumors develop from musculoaponeurotic tissues. They are locally aggressive, but they cannot metastasize. In this case report, we evaluated a patient with a desmoid tumor and the approach to the tumor. A 28-year-old female patient presented with an abdominal mass. She underwent a partial nephrectomy operation on the same side as the mass. Computed tomography revealed a 65x70 mm solid mass on the left abdominal wall. The desmoid tumor was diagnosed by a tru-cut biopsy, the patient was operated on, and the mass was removed. No complications were observed. Desmoid tumors can be classified as extra-abdominal, abdominal, and intra-abdominal according to their location and may cause different symptoms according to their localization. Treatment options should be determined according to the increase in the size of the mass and the symptoms in the patient. [ABSTRACT FROM AUTHOR]

The Chevrel technique is a well-established procedure for open repair of midline incisional hernia. This retrospective single-center case series aims to present the outcome of patients with midline incisional hernia treated with a modified Chevrel technique. The modification itself comprehended the use of a single-layer continuous suture for the inverted anterior rectus abdominis muscle sheet for the creation of the "new linea alba" without overlapping. Between January 2017 and December 2023, 40 patients were operated. The overall postoperative morbidity rate was 65%. Hernia recurrence occurred in three patients (7.5%). When the basic principles of the Chevrel technique are respected and conducted, this leads to satisfactory results. The postoperative outcome of this case series showed rates of complications and recurrences in concordance with the already published literature. Therefore, this technique should always be considered for the open approach for midline incisional hernia repair. [ABSTRACT FROM AUTHOR]

Objectives: To assess needle placement accuracy in the rectus abdominis (RA) muscle during dry needling (DN) without entering the peritoneum. Methods: Two physical therapists performed DN on a cadaver, making 10 attempts each to needle the RA without entering the peritoneum. Techniques followed two common DN approaches. Ultrasound verified needle depth and safety. Results: Seventy percent of attempts were recorded as safe needle placement, while 30% were unsafe. Accurate RA needle placement without peritoneal entry occurred in 55% of attempts. Discussion/Conclusion: Inadvertent peritoneal needle placement during RA DN poses risks regardless of experience. Ultrasound guidance may enhance safety and precision in clinical practice. [ABSTRACT FROM AUTHOR]

Context: Isometric core stability exercises are commonly used to target muscles of the lumbopelvic–hip complex, including the rectus abdominis (RA) and erector spinae (ES). These exercises can be implemented in rehabilitation protocols to increase muscle strength and endurance. Difficulty can be progressed by modifying the base of support or adding an unstable element. Load cells can be affixed to suspension training devices to measure force exerted through the straps during exercise. The primary purpose of this study was to assess the relationship between activity of the RA and ES to force measured through a load cell fixed to suspension straps during bilateral and unilateral suspended bridge exercises. Design: Forty asymptomatic, active individuals completed a single laboratory visit. Methods: Participants completed 2 bilateral suspended bridges and 2 unilateral suspended bridges held to failure. Surface electromyography sensors were placed over the bilateral RA and ES to quantify muscle activity (% maximum voluntary isometric contraction). A load cell was affixed to the suspension straps to measure force exerted through the straps throughout the duration of the exercise. Pearson correlations were used to determine relationships between force and muscle activity of the RA and ES throughout exercise duration. Results: Force was negatively related to RA muscle activity in bilateral suspended bridges (r = −.735 to −.842, P <.001) and unilateral suspended bridges (r = −.300 to −.707, P =.002 to <.001). Force had a positive relationship with ES muscle activity in bilateral suspended bridges (r =.689 to.791, P <.001) and unilateral suspended bridges (r =.418 to.448, P <.001). Conclusions: Suspended bridge exercises can be a valuable tool to target posterior abdominal musculature such as the ES to contribute to core stability and endurance. Load cells can be applied during suspension training to quantify the interaction between individuals and the exercise equipment. [ABSTRACT FROM AUTHOR]

Abstract Background Complex vesico-vaginal fistulae (VVF) pose unique surgical challenges and necessitate the use of interposition tissue to ensure surgical success. Herein, we describe a case of complex VVF with right uretero-vaginal fistula post radical surgery for locally advanced ovarian cancer and chemotherapy in which the rectus abdominis muscle flap was used as the interposition tissue, as the more routine used options such as omentum and peritoneum were removed in the prior radical surgery. Case presentation We describe a case report of a vesico-vaginal and right uretero-vaginal fistula in a 34-year-old female post ovarian cancer radical surgery managed surgically with the traditional transvesical technique of repair and ureteric reimplantation with a unique interposition with rectus abdominis muscle considering the absence of the more routine options. Conclusion Complex VVFs pose unique surgical challenges and necessitate the use of interposition tissue to ensure surgical success. The inferior pedicle based rectus abdominis muscle flap is an excellent interposition tissue for repairs via the transabdominal approach especially in scenarios where the more routine options are unavailable.

Objective: Robotic thoracic surgery provides another minimally invasive approach in addition to video-assisted thoracoscopic surgery (VATS) that yields less pain and faster recovery compared with open surgery. However, robotic incisions are generally placed more inferiorly, which may increase the risk of intercostal nerve injury that affects the abdominal wall. We hypothesized that a robotic approach causes greater ipsilateral rectus muscle atrophy compared with open and VATS approaches. Methods: The cross-sectional area and density of bilateral rectus abdominis muscles were measured on computed tomography scans in patients who underwent lobectomy in 2018. The differences between the contralateral and ipsilateral muscles were compared between preoperative and 6-month surveillance scans. Changes were compared among the open, VATS, and robotic approaches through a mixed effects model after adjustments of correlation and covariates. Results: Of 99 lobectomies, 25 (25.3%) were open, 56 (56.6%) VATS, and 18 (18.1%) robotic. The difference between the contralateral and ipsilateral rectus muscle cross-sectional area was significantly larger at 6 months after robotic surgery compared with open (31.4% vs 9.5%, P = .049) and VATS (31.4% vs 14.1%, P = .021). There were no significant differences in the cross-sectional area between the open and VATS approach. Conclusions: In this retrospective analysis, there was greater ipsilateral rectus muscle atrophy associated with robotic thoracic surgery compared with open or VATS approaches. These findings should be correlated with clinical symptoms and followed to assess for resolution or persistence.

Transversus abdominis release (TAR) is a myofascial release technique which helps in surgical repair of large ventral abdominal wall defects. In this procedure, the medial margin of muscular part of transversus abdominis (TA) is of great importance. Hence, the authors sought to describe the extent of medial margin of TA muscle. The surgical steps of TAR were performed in 10 formalin-fixed cadavers and distance between medial margin of TA muscle, lateral margin of rectus abdominis, to linea alba at five anatomical levels were documented respectively. The distance between the inferior epigastric vessels and the medial border of TA muscle was also noted. The TA muscle was within the posterior rectus sheath in all cadavers, at the xiphisternum (R, 61.6 mm; L, 58.9 mm), and at midway between xiphisternum and umbilicus (R, 25.4 mm; L, 27.1 mm). The TA muscle exited the posterior rectus sheath between this point and the umbilicus. The mean incongruity at the next three levels were -24.6 mm, -24.9 mm, and -22.9 mm respectively on the right and -21.4 mm, -19.9 mm, and -18.9 mm respectively on the left. The mean distance between the medial border of TA and inferior epigastric vessels was 18.9 mm on the right and 17.2 mm on the left. The muscular part of TA was incorporated within the posterior rectus sheath above the umbilicus, and it completely exited the rectus sheath at the umbilicus. This is contrary to the traditional understanding of posterior rectus sheath formation. [ABSTRACT FROM AUTHOR]

Assessing muscle activation during squat and countermovement jumps is crucial for soccer players because these exercises replicate the explosive movements often required in competition, such as jumping for a header. Objective: The objective of this study is to examine the activation patterns of the rectus abdominis, lumbar erector spinae, rectus femoris, and biceps femoris on both the left and right sides in male and female soccer players during squat jumps (SJs) and countermovement jumps (CMJ). Methodology: This cross-sectional study included 30 healthy university-level players (15 males and 15 females). Surface electromyography (Noraxon-USA, MR3 3.8.30) was used to assess the activation patterns of the rectus abdominis, lumbar erector spinae, rectus femoris, and biceps femoris on both sides during SJs and CMJs. Results: The Pearson correlation coefficient was used to determine the relationship between left and right muscle activation patterns in male and female players during both types of jumps, revealing a significant correlation (p < 0.05). Discussion: Females exhibited more consistent left-right synchronization in muscle activation, especially in the core and leg muscles, compared to males, who showed more complex muscle interactions and asymmetries. These findings align with previous research indicating that men and women differ in their neuromuscular activation patterns, co-contraction ratios, and responses to dynamic movements such as jumping. Understanding these gender-specific patterns is important for developing targeted training and injury prevention strategies. Conclusion: The findings indicated that different jump types and genders displayed distinct muscle activation patterns. Females, in particular, demonstrated a significantly stronger correlation between the left and right muscle activation during both jumps compared to males. [ABSTRACT FROM AUTHOR]

Background: Improving early trunk control, balance, and sitting activity following acute stroke is critical for functional prognosis. Purpose: To compare the immediate efficacy of Kinesio Taping® (KT) application on anterior and posterior trunk muscles in terms of improving trunk control, balance, and sit-to-stand performance in the acute stage of stroke. Methods: Sixty-nine patients with acute mild stroke were allocated to the anterior KT group (AKT) (age = 65.95 ± 9.67; 12 females, 11 males; Modified Rankin Score = 3), posterior KT group (PKT) (age = 65.39 ± 10.39; 10 females, 13 males; Modified Rankin Score = 3), and control group (CG) (age = 65.34 ± 8.91; 11 females, 12 males; Modified Rankin Score = 2). Trunk control, balance, and sit-to-stand performance were assessed at the baseline and after 45 minutes and 48 hours post-KT. Data were analyzed using repeated-measures ANOVA. Results: All outcome measures scores improved in all groups significantly after 48 hours (p <.001). A significant improvement after 45 minutes was only seen in trunk control compared to the CG (p <.001; d = 1.32 for AKT and p =.038; d = 0.75 for PKT). Trunk control, balance, and sit-to-stand performance improved in both AKT and PKT compared to the CG at 48 hours post-taping. Trunk control (p <.001; d = 0.26) and balance (p <.001; d = 0.72) results were in favor of the AKT, while sit-to-stand performance results did not make a difference between KT groups (p =.335; d = 0.47). Conclusion: KT application on anterior or posterior trunk muscles was effective for improving trunk control, balance, and sit-to-stand performance in acute stage of stroke in the short term. KT application on anterior trunk muscles had the advantage of improving trunk control and balance. [ABSTRACT FROM AUTHOR]

Purpose: To clarify the association between forced expiration and the abdominal muscles by assessing the relationship between expiratory mouth pressure and abdominal muscle activity in healthy young males. Methods: Twenty-five males underwent forced expiration at 20, 30, 50, 75, and 100% of the maximal expiratory mouth pressure. Mouth pressure was measured using a bridge-type transducer connected to a mouth pressure meter. Abdominal crunch, twist crunch, and abdominal hollowing at maximal voluntary contraction were also performed. During forced expiration and abdominal exercises, the activity of the rectus abdominis (RA), oblique externus abdominis/oblique internus abdominis (OE/OI), and OI/transversus abdominis (OI/TrA) was measured using surface electromyography. Results: The determination coefficient (r2) for the linear relationship between mouth pressure and abdominal muscle activity was 0.86 ± 0.15 for the RA, 0.93 ± 0.06 for the OE/OI, and 0.90 ± 0.14 for the OE/OI. The slope of the linear relationship with r2 ≥ 0.50 showed no significant difference between the RA (0.22 ± 0.27) and the OE/OI (0.27 ± 0.21). However, it was significantly greater in the OI/TrA (1.78 ± 1.41) than in the RA and OE/OI. The OE/OI activity was significantly lower in the maximal forced expiration than in twist crunch, and the OI/TrA activity was not significantly greater in the maximal forced expiration than in twist crunch. Conclusion: All abdominal muscles contribute to forced expiration with a greater contribution of the OI and TrA than the RA and OE. Furthermore, the contribution of the TrA would be greater than that of the OI. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) findings associated with athletic pubalgia are well documented in the adult literature. Objective: To describe the spectrum of MRI findings in adolescents with pubic symphyseal injuries/athletic pubalgia. Materials and methods: This is an institutional review board approved, retrospective study of all patients < 18 years who were referred for MRI, over the last 10 years. Two pediatric musculoskeletal radiologists evaluated the MRI in consensus for the following findings: Chronic Salter-Harris (SH)-I equivalent fracture or asymmetric parasymphyseal ossific fraying, non-retractile muscular tear or retraction, and edema of the aponeurosis and arcuate ligament. Radiographs were also reviewed for Risser stage. Results: Fifteen patients were identified (100% male, median age 17 years, IQR 16–17.6). Most patients (14/15, 93%) had either asymmetric parasymphyseal ossific fraying (4/15, 27%) or chronic SH-1 equivalent fracture (10/15, 67%) of the pubic symphysis, and all patients (15/15, 100%) had aponeurotic and arcuate ligament edema. Few patients had rectus abdominis muscular retraction (2/15, 13%), non-retractile muscular tear of the rectus abdominis (2/15, 13%), and/or adductor muscle (4/15, 27%). Risser stage was as follows: stages 0 (13%), 3 (7%), 4 (47%), and 5 (33%). The injuries in our limited data set were independent of skeletal maturity with no statistically significant association between any of the MRI findings and Risser stage. Conclusion: The MR imaging spectrum of adolescent athletic pubalgia differs from the described findings in adults due to skeletal immaturity. The cleft sign described in adults manifests in adolescents as asymmetric parasymphyseal ossific fraying and chronic SH-1 equivalent fractures. [ABSTRACT FROM AUTHOR]

Abstract The importance and popularity of core training call for ongoing adjustments in exercise selection, overload, and progression to optimize workout outcomes. This study aimed to compare core muscle electromyographic activity during a 45-second isometric contraction under the front plank exercise with a Total-body Resistance Exercise (TRX®) system attached to the upper limbs at varying heights above the ground: a) 10 cm (FP-TRX10); b) 35 cm (FP-TRX35); c) 60 cm (FP-TRX60); and d) 85 cm (FP-TRX85). Twelve physically active male volunteers (mean age: 23.58 ± 2.58 years; mean weight: 75.29 ± 4.23 kg; mean height: 177.04 ± 4.96 cm; mean body fat: 11.57 ± 2.63%), without neuromuscular disorders, participated. Electromyographic signals were recorded from the rectus abdominis (RA), external oblique (EO), internal oblique (IO), erector spinae (ES), and multifidus muscles. Maximum values (root mean square [RMS]) were normalized to maximum voluntary isometric contraction. Statistical analysis was conducted using GraphPad Prism software. Results indicated significantly higher electromyographic activity in the RA, EO, IO, and ES muscles (p < 0.05) during the FP-TRX10 exercise compared to FP-TRX85, with ES muscle activity significantly higher (p < 0.05) in FP-TRX10 than FP-TRX60. Lower TRX® system heights (e.g., FP-TRX10) elicited greater electromyographic activity in most core muscles, highlighting height as a crucial exercise progression factor. FP-TRX10 could represent an advanced step in core training, transitioning from the highest (FP-TRX85) to the lowest point (FP-TRX10) for optimal progression.

Objectives: To compare the inter-rectus distance (IRD), rectus abdominis thickness (RAT), and stiffness in women during pregnancy and postpartum and identify the risk and protective factors affecting diastasis recti abdominis (DRA). Materials and methods: A total of 171 pregnant women who volunteered to participate in this study were recruited. Using an ultrasonographic diagnostic instrument with shear wave elastography function, IRD, RAT and the Young's modulus of the rectus abdominis muscles were measured at 12 weeks, 37 weeks of pregnancy, and 6 weeks postpartum. Results: The IRD at 37 weeks was significantly higher than that at 12 weeks and then decreased at 6 weeks postpartum, but it was still higher than that at 12 weeks (p < 0.001). RAT and Young's modulus decreased significantly at 37 weeks compared with those at 12 weeks and then recovered at 6 weeks postpartum, but they were lower than those at 12 weeks (p < 0.001). IRD at 12 weeks was significantly higher in multiparae than in primiparae (p < 0.001). Moreover, positive correlation between the RAT and Young's modulus of rectus abdominis muscles at 12 and 37 weeks of gestation and 6 weeks postpartum (p < 0.001) was observed. Multiple linear regression analysis showed that the regression equation was significant (f = 24.856, p < 001). Conclusion: Our study identified differences in IRD, thickness and stiffness of the rectus abdominis muscle between early and advanced pregnancy and the postpartum period. The risk and protective factors of DRA may guide pregnant women's protection and treatment. [ABSTRACT FROM AUTHOR]

Problem Statement: Current literature lacks comprehensive research on the manner in which variations in pole dance movements affect core stabilizing muscle activity. Purpose: This study aimed to analyze the electromyographic activity of the rectus abdominis, obliquus externus abdominis, and erector spinae (lumbar) muscles during different pole dance movements using the knee-lock technique to stabilize the body on a vertical bar in horizontal, vertical, and inverted positions. Approach: An experimental study was conducted with a convenience sample of ten female pole dance practitioners, each with over one year of experience in the physical activity. The electromyographic activity of the rectus abdominis, obliquus externus abdominis, and erector spinae lumbar muscles was recorded during the execution of three pole dance movements -- Indian, Genius, and Monkey -- in a randomized and counterbalanced order. The electromyographic signal obtained during all exercises was quantified in the time domain using the root mean square and normalized by the maximal voluntary isometric contraction. Data were collected using simple differential surface electrodes and analyzed using repeated measures analysis of variance. Results: The rectus abdominis, obliquus externus abdominis, and erector spinae lumbar muscles demonstrated greater electromyographic activity during the Genius movement (from moderate to very high activation) compared to the Indian and Monkey moves (low activation). Conclusions: These results can facilitate the selection of movements for possible progression in pole dance training and performance. Additionally, they can be used to increase the muscular resistance and neuromuscular control of the trunk, reduce the risk of injury, and improve overall physical health. [ABSTRACT FROM AUTHOR]

Objective The long-term effects of the unilateral muscle-sparing pedicled transverse rectus abdominis myocutaneous (TRAMmsp) flap procedure on trunk muscle performances and core stability were investigated in women with breast cancer. Methods Forty women (mean age = 42.6 years) who had received breast reconstruction with the unilateral TRAMmsp flap procedure no less than 6 months earlier (mean = 10.3 [standard deviation, SD = 4.9] months) (TRAM group) participated, and 30 women who were healthy and matched for age (mean age = 41.2 years) served as controls (control group). Their abdominal and back muscle strength was assessed using the curl-up and prone extension tests, respectively, and their static abdominal muscle endurance and back extensor endurance were assessed using the sit-up endurance test in the crook-lying position and the Biering-Sørensen test, respectively. Core stability strength was assessed using a 4-level limb-lowering test (abdominal muscle test), and core stability endurance was assessed while lying supine with both flexed legs 1 inch off the mat while keeping the pelvis in a neutral position with a pressure biofeedback unit. Results Compared with the control group, trunk muscles of the TRAM group were weaker, showing less endurance, as were their core stability strength and endurance. Static trunk muscle endurances and trunk flexion strength were associated with core stability in both groups. Conclusions Women exhibit trunk flexor and extensor weakness along with poor endurance and impaired core stability even after an average of 10 months from receiving the TRAMmsp flap procedure. Immobilization after surgery, with possible systemic inflammatory effects from surgery and chemotherapy, might have further contributed to the generalized weakness subsequent to the partial harvesting of the rectus abdominis. Impact Women after breast reconstruction with the TRAMmsp flap procedure show long-lasting deficits of strength and endurance in abdominal muscles, back extensors, and core stability. Proactive measures including early detection and evaluation of impairments as well as timely intervention targeting these clients are important to minimize the dysfunction and support their return to community participation. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose: We present a technique for covering large midline loss of abdominal wall using a novel method by autologous tissues. Methods: Twenty-two patients (body mass index = 35,6 ± 6,9 kg/m2) were involved in the prospective cohort study. Acute and elective cases were included. The gap area was 450.1 ± 54 cm2. The average width of the midline gap was 16,3 ± 3,2 cm. The rectus muscles were mobilized from its posterior sheath. Both muscles were turned by180º medially, so that the complete abdominal wall gap could be covered without considerable tension. Changes in intra-abdominal pressure, quality of life and hernia recurrency were determined. Results: There was no significant increase in the intra-abdominal pressure. Wound infection and seroma occurred in four cases. Bleeding occurred in one case. Pre- and post-operative quality of life index significantly improved (23 ± 13 vs. 47 ± 6; p = 0,0013). One recurrent hernia was registered. The procedure could be performed safely and yielded excellent results. The method was applied in acute cases. The intact anatomical structure of rectus muscles was essential. Conclusions: The midline reconstruction with bilateral turned-over rectus muscles provided low tension abdominal wall status, and it did not require synthetic mesh implantation.

Introduction We performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling. Case presentation At the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1‐h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmH2O. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1‐h pad test resulted in 0 g of leakage. Conclusion We believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery.

Abstract Purpose To compare the safety and efficacy of CPG in the rectus abdominis and intercostal regions. Materials and methods This retrospective study included 226 patients who underwent CPG at a single center, with the stoma placed in the rectus abdominis or intercostal region. Surgical outcomes and complications, such as pain and infection within 6 months postoperatively, were recorded. Results The surgical success rate was 100%, and the all-cause mortality rate within 1 month was 0%. An intercostal stoma was placed in 56 patients; a rectus abdominis stoma was placed in 170 patients. The duration of surgery was longer for intercostal stoma placement (37.66 ± 14.63 min) than for rectus abdominis stoma placement (30.26 ± 12.40 min) (P = 0.000). At 1 month postsurgery, the rate of stoma infection was greater in the intercostal group (32.1%) than in the rectus abdominis group (20.6%), but the difference was not significant (P = 0.077). No significant difference was observed in the infection rate between the two groups at 3 or 6 months postsurgery (P > 0.05). Intercostal stoma patients reported higher pain scores during the perioperative period and at 1 month postsurgery (P = 0.000), but pain scores were similar between the two groups at 3 and 6 months postsurgery. The perioperative complication rates for intercostal and rectus abdominis surgery were 1.8% and 5.3%, respectively (P = 0.464), with no significant difference in the incidence of tube dislodgement (P = 0.514). Patient weight improved significantly at 3 and 6 months postoperatively compared to preoperatively (P

Introduction. Autologous plastic tissues (muscles and greater omentum) are preferable in the reconstruction of chest wall defects in infectious and inflammatory diseases of the chest wall. Extended and deep defects can be eliminated by flaps of the rectus abdominis muscle.Aid. To study the effectiveness of various options for the use of flaps of the rectus abdominis muscle in plastic surgery of chest wall defects of infectious and inflammatory origin.Object and methods. A retrospective analysis of the results of treatment of 34 patients with osteomyelitis of the sternum and ribs of various etiologies was carried out for the period from January 1, 2012 to May 30, 2023. In 32 patients, the main diagnosis was poststernotomy mediastinitis, 2 patients had post-radiation osteomyelitis of the sternum and ribs after combined cancer treatment. mammary gland. The majority of patients (n = 29) underwent a two-stage approach to treatment using vacuum therapy at the stage of relief of acute inflammation. All patients underwent plasty with a flap of the rectus abdominis muscle. The options for surgical intervention and the outcome of treatment were studied.Results. The area of the defect to be repaired in patients ranged from 50 cm2 to 270 cm2 (mean 143.1 ± 15.3 cm2). There were no intraoperative complications in the patients. The postoperative period was complicated by various wound complications in 9 patients. Marginal necrosis of the skin part of the graft was revealed in 3 patients with full-thickness permanent graft plasty. In 3 patients, despite wound drainage, postoperative seromas were detected. Reoperations were performed in 2 patients: in one case, bleeding from the vein of the fullthickness flap was stopped, in the other case, partial necrosis of the full-thickness flap was detected, which required a second operation and revision of the flap. In 1 patient, the hematoma was emptied 3 days after the operation. The average duration of inpatient treatment of patients was 19.3 ± 2.8 days (range 17 to 38 days). There were no lethal outcomes in patients with muscle plasty with a permanent graft flap. In 1 patient, a postoperative hernia was formed in the region of the anterior abdominal wall. Recurrence of osteomyelitis of the ribs was diagnosed in 1 person 16 months after surgery.Conclusions. The rectus abdominis muscle as an isolated and full-thickness flap is the optimal plastic material for eliminating defects in both the lower part of the sternum and extensive defects in the anterior and lateral surfaces of the chest wall.

The management of extensive perineal defects resulting from aggressive tumor resections, such as abdominoperineal resections for advanced pelvic malignancies, can be a complex and demanding process during treatment. The primary options for reconstructing perineal defects are vertical rectus abdominis myocutaneous (VRAM) and anterolateral thigh (ALT) flaps. While both flaps are commonly used in reconstructive surgery, VRAM is often preferred due to several advantages. These include the ability to provide ample tissue to fill large perineal defects, as well as the convenience of harvesting this type of flap through a midline incision. This approach allows for a more cosmetically favorable scar location compared to other techniques. Overall, VRAM is a superior choice for perineal reconstruction due to its versatility and effectiveness in addressing complex defects. In this article, we describe our experience with utilizing a VRAM flap to close a 20x10 cm perineal defect that arose after an abdominoperineal resection performed due to extensive rectal melanoma in a 46-year-old man. We found that the vertical VRAM flap was an exceptional choice for covering this substantial defect in our patient. INSET: 6. [ABSTRACT FROM AUTHOR]

Groin pain is prevalent in orthopedic and sports medicine, causing reduced mobility and limiting sports activity. To effectively manage groin pain, understanding the detailed anatomy of supporting muscles is crucial. This study aimed to investigate the musculoaponeurotic attachments on the pubis and the relationship among intramuscular aponeuroses of abdominal and thigh adductor musculatures. Macroscopic analyses were performed in 10 pelvic halves. The bone morphology of the pubis was assessed in two pelvic halves using microcomputed tomography. Histological investigations were conducted in two pelvic halves. The external oblique aponeurosis extended to the adductor longus aponeurosis, forming conjoined aponeurosis, which attached to a small impression distal to the pubic crest. The gracilis aponeurosis merges with the adductor brevis aponeurosis and is attached to the proximal part of the inferior pubic ramus. The rectus abdominis and pyramidalis aponeuroses were attached to the pubic crest and intermingled with the gracilis-adductor brevis aponeurosis, forming bilateral conjoined aponeurosis, which attached to a broad area covering the anteroinferior surface of the pubis. Histologically, these two areas of conjoined aponeuroses were attached to the pubis via the fibrocartilage enthesis. Microcomputed tomography revealed two distinctive bone morphologies, a small impression and an elongated osseous prominence on pubis, corresponded to the two areas of conjoined aponeuroses. This study demonstrated close relationships between the aponeurotic attachment of the external oblique and adductor longus, and between the rectus abdominis, pyramidalis, gracilis, and adductor brevis. The findings of aponeurotic complexes would aid in diagnostic and surgical approaches for athletic groin pain. [ABSTRACT FROM AUTHOR]

Aims: The plank is a common exercise used to evaluate core function. Surface electromyography (sEMG) and ultrasound can be used simultaneously to measure muscle activity. We aimed to compare the %-thickness and %-activation during the plank performed on three surfaces and to determine agreement and relationship between rectus abdominis (RA) %-thickness of a rested tabletop position and %-activation normalized to quiet tabletop position during the plank on three surfaces. Methods: In this cross-sectional study, ultrasound and sEMG measured RA muscle function during the first 5-s and last 5-s of a plank performed on a table, yoga mat, and fitness ball. A repeated measures ANOVA compared differences in %-thickness change and Friedman's tests compared differences in %-activation, alpha set a priori p ≤ 0.05. Bland–Altman plots measured agreement between instruments. Spearman's rho determined relationships between instruments. Results: There was no difference between %-thickness change across surfaces during the first 5-s or last 5-s, or between %-activation during the last 5-s. The %-activation of the RA during the first 5-s performed on the fitness ball was higher than the table and yoga mat (p < 0.001). Ultrasound and sEMG had weak relationships across all surfaces (ρ = − 0.078 to 0.116). Conclusion: The first 5-s of the plank performed on the fitness ball requires a greater RA activation. Ultrasound could not detect changes in %-thickness of the RA during the plank which may be influenced by the type of contraction. Comparison between these measurement tools during isometric exercise should be used with caution. [ABSTRACT FROM AUTHOR]

In ultrasound diagnostics, acoustic absorbers block unwanted acoustic energy or prevent the reception of echo signals from structures outside the target area. Non-metallic absorbers provide a low-echoic signal that is suitable for observing the anatomy of the area to which the absorber is attached. In this study, we aimed to evaluate the effect of a polyurethane film absorber (PU) on ultrasound diagnostic imaging and investigate its effectiveness in improving the image contrast between the fascia and muscle structures. Twenty-six healthy men in their twenties participated in this study. The experiment was performed with the participant in the supine position and with an ultrasound transducer probe placed at the center of the measurement area on the abdomen. Images of the rectus abdominis (RA; muscle) and rectus sheath, e.g., fascia including superficial fascia (SF) and deep fascia (DF), obtained after attaching a PU, were compared with those obtained without the absorber (No_PU). The thickness was measured using brightness mode ultrasound imaging. To analyze the quantitative differences in the fascia and muscle images depending on the presence of the absorber, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were derived from the signal intensities measured in the target areas. The thickness of the fascia and muscle was similar in all regions of interest, regardless of the absorber; therefore, the existing diagnostic value was maintained. Overall, the signal intensity decreased; however, the SNRs of the RA, SF, and DF differed significantly. The SNR of the RA decreased in the PU but increased for the SF and DF. The CNRs for SF-RA and DF-RA significantly increased with the PU. In this study, we demonstrated that the PU behaved similarly to previously used metallic absorbers, reducing the signal from the attachment site while accurately indicating the attachment site in the ultrasound images. Furthermore, the results showed that the PU efficiently distinguished fascia from surrounding tissues, which could support studies requiring increased signal contrast between fascia and muscle tissue and aid the clinical diagnosis of fascial diseases. [ABSTRACT FROM AUTHOR]

ABSTRACT While diastasis recti (DR) was long neglected by general surgeons, plastic surgeons considered conventional abdominoplasty as the only repair option. However, this scenario has changed recently, either due to a better understanding of the correlation between DR and abdominal wall function and greater risk of recurrence in abdominal hernia repairs, or due to the development of new minimally invasive techniques for repairing DR. One of these surgical procedures consists of the concept of an abdominoplasty, that is, supra-aponeurotic dissection and plication of the DR (with or without abdominal hernia) but performed through three small supra-pubic incisions by laparoscopy or robotic approach. More recently, this procedure has gained new stages. Liposuction and skin retraction technology have been associated with MIS plication of DR, which increases the indications for the technique and potentially improves results. For the first time in the literature, we describe these steps and the synergy between them.

Introduction: Recent studies have related the climacteric period with changes in connective tissue elasticity that may be related to diastasis recti abdominis. Mat Pilates is a method of exercise without impact that currently has more practitioners, due to its satisfactory results. However, there are no studies that evaluate the effectiveness of mat Pilates for women with diastasis recti abdominis. Objective: To evaluate the effectiveness of the mat Pilates program in climacteric women with diastasis recti abdominis. Methods: This randomized single-blinded clinical trial evaluated climacteric women with diastasis recti abdominis. The participants were randomized into the experimental group, which participated in 3 weekly sessions of mat Pilates for 12 weeks for a total of 36 sessions, and the control group (without exercises). The inter-rectus distance was measured with a digital caliper. The G*Power Version 3.1.9.2. software was used for the sample calculation, and the SPSS 20.0 program was used for statistical analysis. Results: The study comprised 21 women, including 10 in the control group and 11 in the experimental group, with mean ages of 54.3 ± 7.1 and 55.3 ± 6.0 years and body mass index values of 28.8 ± 5.5 kg/m2 and 29.9 ± 4.48 kg/m2, respectively. In the experimental group, reductions were observed in all the measures related to diastasis recti abdominis (p

Abstract Background Pilates is expected to have a positive effect on women with weakened abdominal muscles after childbirth. Pilates may have a beneficial effect on the structure and function of the abdominal muscles in pregnant women. Therefore, the objective of this study was to investigate the effects of Pilates on inter-recti distance, thickness of the rectus abdominis, waist circumference, and abdominal muscle endurance in primiparous women. Methods Thirty-five primiparous postpartum women were assigned to either the Pilates exercise group (n = 20) or the control group (n = 15). Pilates was undertaken by the exercise group for 50 min/day, 5 days/week, for 4 weeks. The control group maintained their daily activities without any intervention. The inter-recti distance was measured at three locations along the linea alba, and the thickness of the rectus abdominis was measured using ultrasound. Abdominal muscle endurance was measured using a repeated 1-min curl-up test. Waist circumference was also measured. Results The exercise group showed significant improvements from baseline in inter-recti distance, waist circumference, and abdominal muscle endurance (p

We present a patient who developed an incisional hernia, from epigastrium to umbilicus, after omphalocele repair. The hernia gradually enlarged to a 10 cm × 10 cm defect with significant rectus abdominis muscle diastasis at the costal arch attachment point. At 6 years of age, the abdominal wall defect in the umbilical region was closed using the components separation technique. For the muscle defect of the epigastric region, composite flaps were made by suturing together the flap of the upper rectus abdominis muscle, after peeling it away from the costal arch attachment point, and the vertically inverted flap of the lower rectus abdominis fascia, created with a U-shaped incision. The composite flaps from each side were reversed in the midline to bring them closer and then sutured; the abdominal wall and skin were then closed. Five months after surgery, the patient had no recurrent incisional hernia and no wound complications. [ABSTRACT FROM AUTHOR]

A Spigelian hernia is a hernia through the Spigelian fascia which are difficult to diagnose as they do not present with a subcutaneous swelling and can be dangerous as there is a high risk of incarceration. We report a case of a 51-year-old female who presented to our surgical unit with epigastric pain for 5 days. She was diagnosed with Spigelian hernia with esophagitis and antral gastritis with the help of a computed tomography scan and upper gastrointestinal endoscopy. The diagnosis was confirmed on diagnostic laparoscopy and transabdominal preperitoneal repair of the defect was performed using prolene mesh. Her post-operative period was uneventful. Spigelian hernias are rare and patients can present with atypical symptoms as in this case. Thus, imaging plays a vital role in diagnosis. Management is surgical and has good outcomes.

Background: Pilates is expected to have a positive effect on women with weakened abdominal muscles after childbirth. Pilates may have a beneficial effect on the structure and function of the abdominal muscles in pregnant women. Therefore, the objective of this study was to investigate the effects of Pilates on inter-recti distance, thickness of the rectus abdominis, waist circumference, and abdominal muscle endurance in primiparous women. Methods: Thirty-five primiparous postpartum women were assigned to either the Pilates exercise group (n = 20) or the control group (n = 15). Pilates was undertaken by the exercise group for 50 min/day, 5 days/week, for 4 weeks. The control group maintained their daily activities without any intervention. The inter-recti distance was measured at three locations along the linea alba, and the thickness of the rectus abdominis was measured using ultrasound. Abdominal muscle endurance was measured using a repeated 1-min curl-up test. Waist circumference was also measured. Results: The exercise group showed significant improvements from baseline in inter-recti distance, waist circumference, and abdominal muscle endurance (p < 0.05). The control group showed no significant improvement in these variables. Compared with the control group, the exercise group showed significantly improved performance in terms of inter-recti distance, waist circumference, and abdominal muscle endurance (p < 0.05). Conclusions: The results of this study demonstrate that Pilates was effective in reducing inter-recti distance and waist circumference and improving abdominal muscle endurance in primiparous postpartum women. Pilates is considered an effective exercise for improving muscle structure and function in primiparous postpartum women, helping in the recovery from, and preventing, diastasis rectus abdominis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Postpartum diastasis rectus abdominis have a high incidence, which has a certain adverse effect on the physical and mental health of parturients. Exercise therapy is one of the main treatment methods, but there is still a lack of consensus on which exercise can promote its repair more effectively. OBJECTIVE: To observe the immediate effects of curl-up movement, abdominal breathing, pelvic floor muscle contraction and combined exercise on interrectus distance using high-frequency ultrasound. METHODS: Thirty-nine eligible subjects with postpartum diastasis rectus abdominis were recruited 2-6 months after delivery. Inter-rectus distance was measured using high-frequency ultrasound at 4.5 cm above the umbilicus, at the level of the umbilicus and at 4.5 cm below the umbilicus in five movement patterns: resting state, curl-up movement, abdominal breathing, pelvic floor contraction and combined movement. RESULTS AND CONCLUSION: There was no significant difference in the inter-rectus distance between the resting state and the other four movement patterns at 4.5 cm above the umbilicus (P > 0.05). At the level of the umbilicus, the inter-rectus distance was significantly decreased in the curl-up movement compared with the resting state (P < 0.01), while the inter-rectus distance significantly increased in the combined exercise compared with the resting state (P < 0.05). At the 4.5 cm below the umbilicus, the inter-rectus distance decreased in the curl-up movement compared with the resting state (P < 0.05), while the inter-rectus distance tended to increase in the other three movements compared with the resting state, but there was no statistical difference (P > 0.05). There was no significant difference in the inter-rectus distance between spontaneous delivery group and cesarean section group at the resting state (all P > 0.05). However, at the umbilical level, the inter-rectus distance in the multiparity group was significantly wider than that in the primiparity group (P < 0.05). At 4.5 cm below the umbilicus, the body mass index was positively correlated with the inter-rectus distance (r=0.359, P=0.025). In terms of immediate effects, curl-up movement can reduce the inter-rectus distance, while abdominal breathing, pelvic floor contraction and combined exercise have the opposite effects. Parturients with multiple births and a high body mass index may be more likely to develop postpartum diastasis rectus abdominis. Results from this study will provide a theoretical basis for the rehabilitation treatment of postpartum diastasis rectus abdominis. [ABSTRACT FROM AUTHOR]

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Trunk muscles are required for safety of movement in aging. The authors aimed to investigate the relationship between trunk muscle thickness and the static postural balance in older adults. A total of 31 females and 23 males with a mean age of 73.39 ± 6.09 completed the study. The thickness of the trunk muscles was determined with ultrasound imaging. Postural balance was assessed with force plate. There was a positive weak correlation between right and left upper rectus abdominis muscle thickness and anterior stability area (p <.05, r >.3). The negative and moderate correlation was determined between the left lower rectus abdominis and the perturbated stability sway value (p <.01, r >.5). The increase in trunk muscle thickness in older adults increases the postural stability area and decreases the postural sway especially in the mediolateral direction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Thromboprophylaxis for prevention of venous thromboembolism has significantly decreased morbidity and mortality for post-operative patients over the previous decades. However, patients on anticoagulants are at risk for several major bleeding events, such as rectus sheath hematoma. Rectus sheath hematoma is an uncommon, potentially life-threatening complication that can be difficult to diagnose and easily confused with other abdominal pathologies. It most commonly occurs in patients on current prophylactic or therapeutic anticoagulants and can be spontaneous or provoked. Inadvertent damage to the rectus abdominis muscle or epigastric arteries during subcutaneous enoxaparin injection in the abdomen has been identified as a rare cause of this complication. THE CASE: A 68-year-old hospitalized female presented acute abdominal pain in the right lumbar and iliac region accompanied by hypotension and tachycardia eight days after uncomplicated total knee arthroplasty. She was found to have severe anemia on laboratory exam and a right rectus sheath hematoma on abdominal CT scan with a volume of 300cc. After the patient was stabilized via fluid resuscitation and blood transfusion, the hematoma was surgically drained. The surgeons involved noted possible inadvertent puncture of the right inferior epigastric artery during one of the patient’s bi-daily subcutaneous enoxaparin injections. CONCLUSION: This case report emphasizes the importance of recognizing rectus sheath hematoma as a potential complication of subcutaneous enoxaparin injection and the knowledge of its risk-factors and clinical presentation to make an early diagnosis and give adequate treatment.

Objective To evaluate the distance between rectus abdominis muscle (IRD)and the hardness of primipara during the pregnancy and early postpartum by using two-dimensional ultrasound combined with shear wave elastography (SWE), and to explore the correlation between IRD and the hardness of primipara. Methods From October 2021 to August 2022, a total of 250 primipara who received the regular birth check-up in the Affiliated Hospital of Yunnan University and delivered at full term were selected. During the pregnancy, they were divided into the early pregnancy group, the middle pregnancy group and late pregnancy group based on the gestational age.After the birth, they were then were divided into the natural birth group and the cesarean section group based on the delivery mode. Another 50 healthy non-pregnant women were selected as the control group. The mean elastic modulus of rectus abdominis (Emean) was measured by two-dimensional ultrasound and SWE. The differences of IRD and the rectus abdominis hardness during the pregnancy and postpartum were compared, and the correlation between them was analyzed. Results IRD and the hardness increased with the gestational age and the difference was statistically significant (P < 0.01). IRD of the cesarean section group was higher than that of the vaginal delivery group, and the hardness was lower than that of the vaginal delivery group. BMI during the pregnancy IRD was positively correlated with IRD and the hardness of rectus abdominis muscle (r p = 0.515, 0.641, 0.564, 0.483, 0.513, 0.462, P < 0.01) and IRD was positively correlated with the hardness of rectus abdominis muscle (r p = 0.559, 0.580, 0.425, P < 0.01). Postpartum BMI had no correlation with the hardness of rectus abdominis muscle (r p = −0.113, −0.071, −0.043, −0.005, −0.086, −0.045, P > 0.05), and IRD was negatively correlated with the hardness at 3cm below the umbilical cord (r p = −0.227, P = 0.023). Conclusion　It is feasible to evaluate IRD and the rectus abdominis hardness by 2D ultrasound combined with SWE, which can provide more intuitive clinical basis for the diagnosis and treatment of postpartum rectus abdominis separation. [ABSTRACT FROM AUTHOR]

Nontraumatic spontaneous hematoma of the rectus abdominis is frequently related to anticoagulation therapy. In most cases, this condition is spontaneously self-limited or can be controlled with conservative therapy. Nevertheless, in some patients, despite early and adequate medical therapy, continuous development of the condition requires rapid and complete hemostasis. Currently, endovascular management by selective transarterial embolization of the bleeding vessel is the most common treatment option. We report 2 cases of endovascular management of rectus abdominis hematoma using a mixture of n-butylcyanoacrylate and lipiodol to embolize the bleeding point of the superior epigastric artery. Clinical symptoms improved without noticeable complications.

Objectives: Due to the importance of postpartum maternal health and the effect of pregnancy on the increase of recti diastasis rectus abdominis (DRA), this study aimed to compare the effect of eight weeks of core and Kegel exercise with emphasis on correcting the respiratory pattern on DRA in multiparous women. Methods: This is a semi-experimental study that was conducted on 45 pregnant women who had given birth six weeks ago selected according to the inclusion criteria. Individuals were divided into three selected training groups, including central area, Kegel, and control. The covariance analysis was used for intergroup comparison and a correlated t-test was used for comparison within a group. The statistical analysis was done by SPSS software, version 27. Results: The results of this study showed the effect of both training programs on reducing the distance between the recti-abdominal muscles (P0.045). Discussion: Due to the reduction of pain and DRA, it seems that using the two training programs can lead to desirable results for the people and represents the importance of using the exercises in the postpartum period.

The pedicled transverse rectus abdominis myocutaneous (TRAM) flap is often used during breast reconstruction. After completely elevating the flap, a medial tunnel is created to connect the dissection area to the mastectomy defect. This tunnel should typically accommodate four of the surgeon’s fingers, although this may vary depending on flap volume. Wider tunneling facilitates flap delivery, but can damage the breast and inframammary fold. Therefore, we introduce a technique to move the flap easily and safely through a small tunnel. During breast reconstruction using a pedicled TRAM flap, a tunnel was made in the mastectomy defect along the meridian of the breast. This tunnel accommodated a width of three of the surgeon’s fingers (6 cm). After completely elevating the flap, it was inserted into a funnel with an inner surface made of polymeric vinyl and a hydrophilic coating. The flap was propelled into the mastectomy defect via the funnel. Our novel technique for pedicled TRAM flap delivery using a funnel was easy and safe, and it is deemed to be suitable for delivering a pedicled TRAM flap.